12 tips when buying health insurance

When you decide to invest in health insurance, you’ll likely have many questions. Which provider should you choose, how much coverage do you need, and how much will it all cost? Our tips will help you consider your options and find the best policy for your needs.

1. Why do you want health insurance?

Before you choose a health insurance plan, ask yourself why you’re doing it. What’s motivated you to invest in health insurance now? You may have seen news reports about NHS waiting lists and are concerned about the waiting time you might face if you need treatment. There may be a family history of a particular condition, and you want to be able to access private healthcare. Some people invest in health insurance because they’re struggling to get an appointment with their NHS GP or they’ve become parents and want to have support for their family.

Insurance providers vary in the coverage they offer. The right health insurance plan and provider for you can depend on what you want your health insurance plan to do.

2. Who do you want the policy to cover?

Choosing a couples or family health insurance plan can reduce the cost of your health insurance per person. However, other factors are worth considering depending on who you want your health insurance plan to cover.

While similarities exist in the basic coverage each insurance company offers, there are differences in the services they provide. Some providers have family-friendly policies and services. For example, Freedom Health Insurance will cover your children on a family policy until they’re 25, even if they don’t live with you. Others only charge you for your first child and cover subsequent children for free. Bupa provides a family mental health helpline so you can seek advice about your child’s emotional well-being, even if they aren’t covered.

3. What coverage do you need?

Private health insurance plans offer different types of coverage depending on your chosen policy. Every health insurance plan has core coverage, and you can also add optional extras. Some insurance companies offer various policy levels with a package of coverage options.

Here are some types of coverage you can expect to see on a basic health insurance plan and optional extras that you can add as needed.

Standard coverage

Each insurance company will include the same types of coverage within their basic health insurance plans. The medical treatment each policy category offers varies between insurers, as will the financial limits and number of sessions you can expect to receive.

Inpatient and day-patient care

Inpatient care is any treatment needing a hospital admission. Health insurance also covers day-patient care, where you spend a few hours in a day-patient unit but go home in the evening.

Inpatient coverage pays for your treatment and accommodation costs. You’ll usually have a private room when you have private health insurance. Private hospitals often have hotel-style facilities such as an ensuite bathroom, a TV and a choice of meals.

Cancer care

50% of us will get cancer during our lifetime, which probably explains why every health insurance company includes cancer care with every policy. Most health insurance plans will usually cover surgery, radiotherapy and chemotherapy. You may also be able to access other support services, such as advice about wigs, prosthetics and nutritional advice.

Some insurers even include stem cell therapy and genetic testing, although you may need to pay a higher premium to enhance your coverage. It’s worth checking what types of cancer care your insurance company pays for if comprehensive cancer coverage is important to you.

Mental health support

We’ve all become more aware of the need to look after our mental health. Most health insurance policies include some mental health support as standard. Support services typically include access to a mental health support line or online resources. Some health insurance plans also allow you to self-refer for a short course of CBT or counselling without needing to see your GP.

Health insurance also provides access to perks and discounts, some of which can help you manage your mental health day-to-day. For example, Vitality’s rewards program includes a discount on the Headspace app, which provides mindfulness and meditation tools.

Virtual GP services

If you’re considering buying health insurance because getting an appointment with your GP has become a challenge, virtual GP services will likely be a real benefit. Virtual or digital GP services are available 24/7, so you can fit them around your other commitments. You can book video appointments online. Some services ask you to enter your symptoms into an app, and a healthcare professional will call you back.

Most health insurance also includes telephone helplines for general medical advice. These aren’t always available 24/7 but do offer extended hours.

4. Optional extras

Choosing enhanced health insurance plan options lets you increase the amount of coverage you receive and tailor your plan to suit your needs. Some health insurance options come as part of a package, while others let you add specific types of coverage individually. Here are a few of the elements you can expect to find.

Outpatient treatment

When you include outpatient coverage as part of your health insurance, your insurance company pays for treatment costs that don’t need a hospital admission, such as physiotherapy. Crucially, outpatient coverage also pays for consultant appointments, diagnostic tests, and scans.

If your health insurance only includes inpatient coverage, you’ll need to go to the NHS for a diagnosis and then ask for a referral to allow you to have private medical care. If your policy covers outpatient treatment, you can use your health insurance to see a consultant and have tests to get your diagnosis, which will likely make the whole process much quicker.

We think it’s worth investing in outpatient coverage when buying health insurance. Even a small amount can be enough to cover a quick diagnosis.

Optical and dental coverage

Finding a dentist or optician offering NHS care can be challenging, even if you qualify for free optical or dental care. If you already pay privately, adding optical and dental coverage to your health insurance could help you to save money.

Additional therapies

Private medical insurance can give you access to cutting-edge medical treatment and medications unavailable on the NHS. This is usually because private medical providers prioritise investing in new technologies to offer their customers a high standard of care.

However, suppose you want your private health insurance to include alternative therapies such as acupuncture, homoeopathy or chiropractic treatment. In that case, you’ll need to pay more to add them to your policy.

6. Look for a policy you can tailor easily

When you start researching before buying health insurance, you’ll find differences in how each insurance company tailors its plans. As we’ve mentioned, you may discover structured packages with different levels of coverage. These can be ideal if you want a good comprehensive policy that covers all the bases and don’t have any particular health concerns in mind. However, it also runs the risk of paying for something you don’t use.

You may want to ensure that diagnostic tests and scans are covered and that you have the best health insurance plan for cancer treatment. At the same time, you might not be interested in alternative therapies. Flexible private medical insurance lets you handpick and tailor each element to suit your priorities and fit your budget.

7. Consider the additional benefits

Private health insurance doesn’t just give you access to private medical care. Every insurance company also includes perks and benefits for their policyholders. These typically include free or discounted products and services. For example, you might be able to claim a free coffee once a week, get 2-for-1 cinema tickets or a discount on your next family holiday. These benefits can mean that paying your health insurance premium helps you to save money on treats or things you’d usually buy, so it’s worth checking what’s available when choosing an insurance company.

Vitality’s private medical insurance focuses on supporting its members to maintain or improve their health. Its rewards program gives you additional discounts when you achieve your well-being goals.

8. Ask what exclusions apply to the policy

Every health plan has exclusions; some are standard clauses that apply to every policyholder, while others depend on your medical history. Understanding exclusions can help you make an informed choice about the right health insurance plan.

Chronic conditions

A chronic condition is any illness your doctor can manage but not cure. Typical examples include asthma, diabetes, high blood pressure or angina. Health insurance covers private medical care for acute conditions. If you have an ongoing condition that needs regular monitoring and management, you’ll need to stick with the NHS for your care.

Standard exclusions

Every insurance company has policy exclusions for specific types of care. These typically include:

Emergency carePregnancy and birth (although some cover pregnancy-related complications)Cosmetic surgeryTherapy or rehabilitation for alcoholism and addiction

Some policies also exclude self-inflicted injuries, which can include injuries from participation in extreme sports. Whilst the list above details standard exclusions, every insurance company is different; some have more exclusions than others. We always recommend you check the small print before you choose your policy.

Pre-existing conditions

Before choosing a health insurance policy and what coverage you want to include, it’s a good idea to consider your medical history. Medical insurance only covers new acute conditions that arise after you buy your policy. Anything you sought advice or care for before will be excluded, although that won’t apply if you’ve been symptom-free for five years before buying health insurance. If your pre-existing condition doesn’t reoccur in the first two years of the policy, it can be added after that.

Suppose you know that your pre-existing condition will affect your ability to use some parts of your health insurance (for example, any outpatient cover). In that case, this can help you to choose suitable policy options.

9. Buy your policy before you need treatment

If you’ve just started experiencing symptoms or received a diagnosis, you might be looking for medical insurance to help you get private care. However, it likely won’t; your insurers could even consider it fraud.

The claims process varies depending on the type of underwriting you have on your policy. If you have full medical underwriting, you’ll need to provide medical information upfront. If moratorium underwriting applies, your insurance company will ask for information from your doctor when you claim to check whether the medical treatments you need are covered.

If you claim shortly after buying health insurance, they’ll likely scrutinise your claim closely to check whether you may have purchased insurance knowing you already had a health issue. The best approach is to choose your health insurance policy when you’re well, so it’s there when you need it.

10. Where do you want to have treatment?

You can choose where you’re treated, whether you receive private or NHS health care. When you buy a health plan, your policy will include a hospital list detailing all the hospitals and treatment centres that your policy covers. Depending on your chosen insurance company, these could include their own hospitals, private facilities run by other health care providers and private rooms in NHS hospitals.

If you have specific priorities about the health care you receive, you can check to see which provider meets your needs. For example, you may want certain facilities or prefer to go to a hospital near home.

Standard hospital lists tend to include hospitals with lower healthcare costs. Costs are typically higher in London and other major cities simply because they must pay more in wages and facilities expenses. Insurance companies cover this by including higher-cost treatment centres on their enhanced hospital lists, only available if you pay a higher monthly premium. It’s worth shopping around for the best value for a hospital or treatment centre that fits your needs.

12. Think about your budget

You might already have a rough idea about how much you expect to pay for your health insurance. Alternatively, you can get some quotes and adjust the policy to fit your budget. Tailoring your plan allows you to spend money on the things that are most important to you. However, this can mean making compromises elsewhere.

You can save money by choosing a basic plan, adding dental or optical cover to reduce your overall spending or taking advantage of the discounts your policy includes. If you want policy coverage for your children or partner, this can also reduce the cost per person.

Here are a few more ways you can achieve lower monthly premiums.

Guided consultant choice

Most policies give you free choice over the consultant you see, meaning you can act on recommendations from family or friends or see someone specialising in the type of surgery you need. However, if you find too many choices overwhelming or are happy for your insurance company to recommend someone, guided consultant choice is ideal. When you claim, your insurer will list 3-5 consultants with the right expertise. You can do some research to see who you prefer before deciding.

The consultants on a guided list charge lower fees, saving you money on your premiums.

Increase your policy excess

The excess on your health insurance is the amount you’ll contribute towards your care before your insurance policy covers the rest. Increasing the excess will reduce your premiums.

You’ll pay the excess every time you claim, so it’s vital to ensure it’s affordable. A higher excess can mean you only use your health insurance for more serious illnesses while using the NHS for minor ailments or injuries.

Add a 6-week wait

A 6-week wait clause says that your health insurance will only pay for your care if you wait longer than six weeks on the NHS. This can be ideal in some circumstances. For example, say your GP has exhausted all other options to treat arthritis in your hip and recommends a hip replacement. You discover that the average wait at your local hospital is over two years, so you can go to your health insurer to claim.

However, if you fall and break your hip, you’ll likely be taken straight to the hospital in an ambulance, which means you’ve waited less than six weeks and won’t be able to have any follow-up surgery privately.

Speak to a broker

There’s a lot to think about when choosing private health insurance. There are many providers, and they all assess risk differently, meaning no two policies or premiums are the same. Talking to a good broker can give you advice tailored to your needs and priorities. Specialist brokers have in-depth knowledge of the health insurance marketplace and will research to find the right policy for you. They’ll also help you to compare quotes so you know what you’re getting before you choose your policy.

Get in touch

MyTribe guides help you understand health insurance and make an informed choice about the right policy for you. Contact us for a comparison quote, and we’ll put you in touch with a high-quality, regulated broker for tailored advice.

Disclaimer: This information is general and what is best for you will depend on your personal circumstances. Please speak with a financial adviser or do your own research before making a decision.